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Baschieri F, Vitiello M, Cortelli P, Calandra-Buonaura G, Morgante F. Autonomic dysfunction in progressive supranuclear palsy. J Neurol 2023; 270:109-129. [PMID: 36042018 DOI: 10.1007/s00415-022-11347-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND The degree of involvement of the autonomic nervous system in progressive supranuclear palsy (PSP) has been investigated in several studies, often providing conflicting results. There is a need for a better characterization of autonomic dysfunction in PSP, to enhance our understanding of this highly disabling neurodegenerative disease including patients' needs and possibly be of value for clinicians in the differential diagnosis among Parkinsonian syndromes. METHODS We applied a systematic methodology to review existing literature on Pubmed regarding autonomic nervous system involvement in PSP. RESULTS PSP reported quite frequently symptoms suggestive of autonomic dysfunction in all domains. Cardiovascular autonomic testing showed in some cases a certain degree of impairment (never severe). There was some evidence suggesting bladder dysfunction particularly in the storage phase. Dysphagia and constipation were the most common gastrointestinal symptoms. Instrumental tests seemed to confirm sudomotor and pupillomotor disturbances. CONCLUSIONS PSP patients frequently reported visceral symptoms, however objective testing showed that not always these reflected actual autonomic impairment. Further studies are needed to better delineate autonomic profile and its prognostic role in PSP.
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Affiliation(s)
- Francesca Baschieri
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Maria Vitiello
- Neurology Unit, "M. Bufalini" Hospital, AUSL Romagna, Cesena, Italy
| | - Pietro Cortelli
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giovanna Calandra-Buonaura
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy. .,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.,Department of Experimental and Clinical Medicine, University of Messina, Messina, Italy
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Kermorgant M, Fernagut PO, Meissner WG, Arvanitis DN, N'Guyen D, Senard JM, Pavy-Le Traon A. Age and Gender Differences in Cardiovascular Autonomic Failure in the Transgenic PLP-syn Mouse, a Model of Multiple System Atrophy. Front Neurol 2022; 13:874155. [PMID: 35720100 PMCID: PMC9201283 DOI: 10.3389/fneur.2022.874155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/11/2022] [Indexed: 12/02/2022] Open
Abstract
Multiple system atrophy (MSA) is a rare and progressive neurodegenerative disorder. Autonomic failure (AF) is one main clinical feature which has a significant impact on health-related quality of life. The neuropathological hallmark of MSA is the abnormal accumulation of α-synuclein in oligodendrocytes forming glial cytoplasmic inclusions. Only little is known about gender and age differences in AF in MSA. This study was carried out in 6 and 12 months old transgenic PLP-α-syn and WT male and female mice. Heart rate variability (HRV) was assessed both in time, frequential and non-linear domains. Baroreflex sensitivity (BRS) was estimated by the sequence method. Duration of ventricular depolarization and repolarization (QT/QTc intervals) were evaluated from the ECG signals. Three-way ANOVA (genotype x gender x age) with Sidak's method post-hoc was used to analyze data. BRS was significantly changed in PLP-α-syn mice and was age-dependent. QT and QTc intervals were not significantly modified in PLP-α-syn mice. An impaired HRV was observed at 12 months of age in PLP-α-syn female but not in male mice, indicative of cardiovascular AF.
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Affiliation(s)
- Marc Kermorgant
- INSERM DR Midi-Pyrénées Limousin, Institute of Cardiovascular and Metabolic Diseases (I2MC) UMR1297, University Hospital of Toulouse, Toulouse, France
- French Reference Center for Multiple System Atrophy, Neurology Department, University Hospital of Toulouse, Toulouse, France
- *Correspondence: Marc Kermorgant
| | - Pierre-Olivier Fernagut
- Univ. Bordeaux, CNRS, IMN, UMR 5293, Bordeaux, France
- Laboratoire de Neurosciences Expérimentales et Cliniques INSERM U1084, University of Poitiers, Poitiers, France
| | - Wassilios G. Meissner
- Univ. Bordeaux, CNRS, IMN, UMR 5293, Bordeaux, France
- CRMR AMS, Service de Neurologie - Maladies Neurodégénératives, CHU de Bordeaux, Bordeaux, France
- Department of Medicine, University of Otago, Christchurch, New Zealand
- New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Dina N. Arvanitis
- INSERM DR Midi-Pyrénées Limousin, Institute of Cardiovascular and Metabolic Diseases (I2MC) UMR1297, University Hospital of Toulouse, Toulouse, France
| | - Du N'Guyen
- INSERM DR Midi-Pyrénées Limousin, Institute of Cardiovascular and Metabolic Diseases (I2MC) UMR1297, University Hospital of Toulouse, Toulouse, France
| | - Jean-Michel Senard
- INSERM DR Midi-Pyrénées Limousin, Institute of Cardiovascular and Metabolic Diseases (I2MC) UMR1297, University Hospital of Toulouse, Toulouse, France
- Department of Clinical Pharmacology, University Hospital of Toulouse, Toulouse, France
| | - Anne Pavy-Le Traon
- INSERM DR Midi-Pyrénées Limousin, Institute of Cardiovascular and Metabolic Diseases (I2MC) UMR1297, University Hospital of Toulouse, Toulouse, France
- French Reference Center for Multiple System Atrophy, Neurology Department, University Hospital of Toulouse, Toulouse, France
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3
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Yuphiwa Ngomane A, Martins de Abreu R, Fernandes B, Roque Marçal I, Veiga Guimarães G, Gomes Ciolac E. Analysis of Cardiovascular Hemodynamic and Autonomic Variables in Individuals with Systemic Arterial Hypertension, Type 2 Diabetes Mellitus, and Parkinson's Disease: A Comparative Study. Clin Exp Hypertens 2021; 44:119-126. [PMID: 34875941 DOI: 10.1080/10641963.2021.2001480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Systemic arterial hypertension (SAH), type 2 diabetes mellitus (T2DM), and Parkinson's disease (PD) are highly prevalent chronic diseases that can significantly impact the cardiovascular system. AIM The aim of this study was to compare hemodynamic and autonomic variables at rest in individuals with SAH, T2DM, or PD. METHODS Fifty sedentary or insufficiently active individuals (22 men) with SAH (age = 66 ± 5.0 yr), T2DM (age = 52 ± 10 yr) or PD (age = 68 ± 8.0 yr) had their resting blood pressure (BP), arterial stiffness, endothelial function, and heart rate variability (HRV) assessed and compared. RESULTS Systolic and diastolic BP were higher in SAH (130 ± 10 / 80 ± 10 mmHg) than T2DM (110 ± 14 / 75 ± 11 mmHg) and PD, and (123 ± 20 / 70 ± 11 mmHg) respectively. T2DM individuals showed lower arterial stiffness (8.4 ± 1.1 m/s), when compared to SAH (10.3 ± 2.3 m/s) and PD (10.6 ± 3.0 m/s). T2DM had greater resting tachycardia showed by the mean RR (759 ± 79 ms), than SAH (962 ± 169 ms) and PD (976 ± 134 ms), which was accompanied by higher sympathetic modulation (low frequency [LF]: 62 ± 19 nu) and lower parasympathetic modulation (high frequency [HF]: 32 ± 16 nu) when compared to SAH (LF: 40 ± 16 nu; HF: 61 ± 33 nu). No differences among groups were found on non-linear HRV markers and endothelial reactivity indexes. CONCLUSIONS Individuals with T2DM showed impaired levels of cardiac autonomic markers when compared to individuals with SAH and PD, despite of having lower levels of BP and arterial stiffness.
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Affiliation(s)
- Awassi Yuphiwa Ngomane
- São Paulo State University (UNESP), School of Sciences, Department of Physical Education, Exercise and Chronic Disease Research Laboratory, Bauru, Brazil
| | - Raphael Martins de Abreu
- Federal University of S'ão Carlos (UFSCar), Center of Biological and Health Sciences, Department of Physical Therapy, Cardiovascular Physical Therapy Laboratory, Sao Carlos, Brazil
| | - Bianca Fernandes
- São Paulo State University (UNESP), School of Sciences, Department of Physical Education, Exercise and Chronic Disease Research Laboratory, Bauru, Brazil
| | - Isabela Roque Marçal
- São Paulo State University (UNESP), School of Sciences, Department of Physical Education, Exercise and Chronic Disease Research Laboratory, Bauru, Brazil
| | | | - Emmanuel Gomes Ciolac
- São Paulo State University (UNESP), School of Sciences, Department of Physical Education, Exercise and Chronic Disease Research Laboratory, Bauru, Brazil
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Terzaghi M, Pilati L, Ghiotto N, Arnaldi D, Versino M, Rustioni V, Rustioni G, Sartori I, Manni R. Twenty-four hour blood pressure profile in idiopathic REM sleep behaviour disorder. Sleep 2021; 45:6374537. [PMID: 34555174 DOI: 10.1093/sleep/zsab239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/07/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES To determine whether autonomic dysfunction in idiopathic REM sleep behaviour disorder (iRBD) affects circadian blood pressure (BP) profile. METHODS 21 iRBD (mean age 68.8±6.4, mean age at onset 62.2±9.3), 21 drug-free de novo Parkinson's disease (PD) subjects and 21 control subjects (HCs), comparable for age and sex, underwent 24-hour ambulatory BP monitoring. A prospective follow-up study was performed to evaluate the occurrence of neurodegenerative disorders in the iRBD cohort. RESULTS In the iRBD group, night-time systolic BP (SBP) was higher (124.0±20.0, p=.026), nocturnal BP decrease lower (4.0±8.7% for SBP and 8.7±8.0% for DBP, p=.001), and non-dipping status more frequent (71.4% for systolic and 52.4% for diastolic BP; p=.001 and p=.01 respectively) than in the HCs. Reverse dipping of SBP was found in 23.8% (p=.048) of the iRBD subjects. Non-dipping status was not associated with differences in gender, age, disease duration, age at disease onset, UPDRS score, presence of antihypertensive therapy or polysomnographic measures. Patients with PD showed daytime and night-time BP profiles comparable to those observed in iRBD. A sub-group analysis considering only the subjects without antihypertensive therapy (12 iRBD, 12 PD) showed results superimposable on those of the whole iRBD and PD groups.Longitudinal follow up (mean 5.1±1.9 years) showed no differences in BP profile at baseline between converters (n=6) and non-converters. CONCLUSIONS 24-hour BP control was impaired in iRBD. This impairment, similar to patterns observed in de novo PD, consisted of reduced amplitude of nocturnal dipping and increased frequency of non-dipping status. These findings could have implications for cardiovascular morbidity and mortality in iRBD.
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Affiliation(s)
- Michele Terzaghi
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Laura Pilati
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy.,Department of Biomedicine and Clinical Neuroscience, University of Palermo, Italy
| | - Natascia Ghiotto
- Interinstitutional Center of Neurological Medicine, IRCCS Mondino Foundation, Pavia, Italy
| | - Dario Arnaldi
- Clinical Neurology, DINOGMI, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maurizio Versino
- Neurology and Stroke Unit, ASST Sette laghi Ospedale di Circolo, Varese; DMC University of Insubria, Varese, Italy
| | - Valter Rustioni
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Gianluca Rustioni
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Ivana Sartori
- C. Munari Center of Epilepsy Surgery, Niguarda Hospital, Milan, Italy
| | - Raffaele Manni
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
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Sabino-Carvalho JL, Fisher JP, Vianna LC. Autonomic Function in Patients With Parkinson's Disease: From Rest to Exercise. Front Physiol 2021; 12:626640. [PMID: 33815139 PMCID: PMC8017184 DOI: 10.3389/fphys.2021.626640] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 02/24/2021] [Indexed: 12/16/2022] Open
Abstract
Parkinson’s disease (PD) is a common neurodegenerative disorder classically characterized by symptoms of motor impairment (e.g., tremor and rigidity), but also presenting with important non-motor impairments. There is evidence for the reduced activity of both the parasympathetic and sympathetic limbs of the autonomic nervous system at rest in PD. Moreover, inappropriate autonomic adjustments accompany exercise, which can lead to inadequate hemodynamic responses, the failure to match the metabolic demands of working skeletal muscle and exercise intolerance. The underlying mechanisms remain unclear, but relevant alterations in several discrete central regions (e.g., dorsal motor nucleus of the vagus nerve, intermediolateral cell column) have been identified. Herein, we critically evaluate the clinically significant and complex associations between the autonomic dysfunction, fatigue and exercise capacity in PD.
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Affiliation(s)
- Jeann L Sabino-Carvalho
- NeuroV̇ASQ̇ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, Brazil
| | - James P Fisher
- Manaaki Mānawa - The Centre for Heart Research, Department of Physiology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Lauro C Vianna
- NeuroV̇ASQ̇ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, Brazil.,Graduate Program in Medical Sciences, Faculty of Medicine, University of Brasília, Brasília, Brazil
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6
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Sabino-Carvalho JL, Falquetto B, Takakura AC, Vianna LC. Baroreflex dysfunction in Parkinson's disease: integration of central and peripheral mechanisms. J Neurophysiol 2021; 125:1425-1439. [PMID: 33625931 DOI: 10.1152/jn.00548.2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The incidence of Parkinson's disease (PD) is increasing worldwide. Although the PD hallmark is the motor impairments, nonmotor dysfunctions are now becoming more recognized. Recently, studies have suggested that baroreflex dysfunction is one of the underlying mechanisms of cardiovascular dysregulation observed in patients with PD. However, the large body of literature on baroreflex function in PD is unclear. The baroreflex system plays a major role in the autonomic, and ultimately blood pressure and heart rate, adjustments that accompany acute cardiovascular stressors on a daily basis. Therefore, impaired baroreflex function (i.e., decreased sensitivity or gain) can lead to altered neural cardiovascular responses. Since PD affects parasympathetic and sympathetic branches of the autonomic nervous system and both are orchestrated by the baroreflex system, understanding of this crucial mechanism in PD is necessary. In the present review, we summarize the potential altered central and peripheral mechanisms affecting the feedback-controlled loops that comprise the reflex arc in patients with PD. Major factors including arterial stiffness, reduced number of C1 and activation of non-C1 neurons, presence of central α-synuclein aggregation, cardiac sympathetic denervation, attenuated muscle sympathetic nerve activity, and lower norepinephrine release could compromise baroreflex function in PD. Results from patients with PD and from animal models of PD provide the reader with a clearer picture of baroreflex function in this clinical condition. By doing so, our intent is to stimulate future studies to evaluate several unanswered questions in this research area.
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Affiliation(s)
- Jeann L Sabino-Carvalho
- NeuroV̇ASQ̇-Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, DF, Brazil
| | - Barbara Falquetto
- Department of Pharmacology, Institute of Biomedical Sciences, University de Sao Paulo, Sao Paulo, Brazil
| | - Ana C Takakura
- Department of Pharmacology, Institute of Biomedical Sciences, University de Sao Paulo, Sao Paulo, Brazil
| | - Lauro C Vianna
- NeuroV̇ASQ̇-Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, DF, Brazil.,Graduate Program in Medical Sciences, Faculty of Medicine, University of Brasília, Brasília, DF, Brazil
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7
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Sabino-Carvalho JL, Cartafina RA, Guimarães GM, Brandão PRP, Lang JA, Vianna LC. Baroreflex function in Parkinson's disease: insights from the modified-Oxford technique. J Neurophysiol 2020; 124:1144-1151. [PMID: 32877297 DOI: 10.1152/jn.00443.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Nonmotor symptoms are common in Parkinson's disease (PD) and they include dysregulation of cardiovascular system, which adversely affects quality of life. Recent studies provide indirect evidence that baroreflex dysfunction may be one of the mechanisms of cardiovascular dysregulation in PD. Herein, we tested the hypothesis that the baroreflex gain, assessed across an extensive range of the reflex arc by eliciting rapid changes in blood pressure (BP) induced by sequential boluses of vasoactive drugs (modified-Oxford technique) would be attenuated in middle-aged patients with PD. Beat-to-beat heart rate (electrocardiography) and BP (finger photoplethysmography) were obtained during 10 min of supine rest preceding the modified-Oxford (bolus of nitroprusside followed by phenylephrine 1 min afterward) in 11 patients with PD (51 ± 6 yr) and 7 age-matched controls (47 ± 6 yr). The resulting systolic BP and R-R interval responses were plotted and fitted with segmental linear regression and symmetric sigmoid model. Spontaneous indices obtained via sequence technique were also used to estimate baroreflex gain. Compared with controls, the estimated gains measured by segmental linear regression (patients: 3.83 ± 2.6 ms/mmHg versus controls: 7.78 ± 1.7 ms/mmHg; P = 0.003) and symmetric sigmoid model (patients: 12.36 ± 6.9 ms/mmHg versus controls: 32.02 ± 19.0 ms/mmHg; P = 0.009) were lower in patients with PD. The operating range of BP was larger in patients with PD compared with controls (13 ± 7 mmHg versus controls: 7 ± 3 mmHg; P = 0.032). Of note, the gain obtained from spontaneous indices was similar between groups. These data indicate that baroreflex gain was reduced by >50% in PD, thereby providing clear and direct evidence that cardiovagal baroreflex dysfunction occurs in PD.NEW & NOTEWORTHY Attenuated baroreflex gain may contribute to adverse cardiovascular outcomes, including orthostatic intolerance symptoms typically observed in patients with Parkinson's disease. We found that the baroreflex gain (assessed by the modified-Oxford technique) is attenuated and accompanied by an increased operating range in patients with Parkinson's disease. These findings highlight that cardiovascular perturbations are required to detect baroreflex impairments and that spontaneous indices do not reveal cardiovagal-baroreflex dysfunction in a middle-aged group of patients with Parkinson's disease.
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Affiliation(s)
| | - Roberta A Cartafina
- NeuroV̇ASQ̇ - Integrative Physiology Laboratory, University of Brasília, Brazil
| | - Gabriel M Guimarães
- NeuroV̇ASQ̇ - Integrative Physiology Laboratory, University of Brasília, Brazil
| | - Pedro R P Brandão
- Neuroscience & Behavior Laboratory, University of Brasilia, Brasília, Brazil
| | - James A Lang
- Department of Kinesiology, Iowa State University, Ames, Iowa
| | - Lauro C Vianna
- NeuroV̇ASQ̇ - Integrative Physiology Laboratory, University of Brasília, Brazil.,Graduate Program in Medical Sciences, Faculty of Medicine, University of Brasília, Brazil
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8
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Tamuli D, Kaur M, Boligarla A, Jaryal AK, Srivastava AK, Deepak KK. Depressed baroreflex sensitivity from spontaneous oscillations of heart rate and blood pressure in SCA1 and SCA2. Acta Neurol Scand 2019; 140:350-358. [PMID: 31343735 DOI: 10.1111/ane.13151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/20/2019] [Accepted: 07/21/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To assess the time and frequency domain measures of cardiac autonomic activity/tone in patients of genetically defined spinocerebellar ataxia (SCA) types 1 and 2, as well as to decipher the probable associations among the cardiovascular autonomic parameters and genetic and clinical characteristics. MATERIALS AND METHODS Simultaneous 5-min recording of RR interval (RRI) and blood pressure (BP) for the calculation of heart rate variability (HRV), blood pressure variability (BPV) and baroreflex sensitivity (BRS) were performed in genotypically confirmed SCA1 (n = 31) and SCA2 (n = 40) patients and healthy controls (n = 40). Additionally, the International Cooperative Ataxia Rating Scale (ICARS) was used for scoring of clinical severity in SCA patients. RESULTS Time and frequency domain parameters of HRV, BPV and BRS were depressed in SCA1 and SCA2 subtypes as compared to controls, although there was no statistically significant difference in autonomic tone between the two SCA subtypes. On correlation analysis, autonomic tone parameters were found to be associated with the clinical and genetic features of the SCA subtypes. Also, ICARS was associated with the genotype (CAG repeat length) in SCA2 patents. CONCLUSIONS Cardiac autonomic tone is depressed in both SCA1 and 2 as compared to healthy controls while the two SCA subtypes do not differ in terms of autonomic tone. Also, a typical association exists between disease characteristics and autonomic indices.
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Affiliation(s)
- Dibashree Tamuli
- Department of Physiology All India Institute of Medical Sciences New Delhi India
| | - Manpreet Kaur
- Department of Physiology VMMC & Safdarjung Hospital New Delhi India
| | - Anasuya Boligarla
- Department of Physiology All India Institute of Medical Sciences New Delhi India
| | - Ashok K. Jaryal
- Department of Physiology All India Institute of Medical Sciences New Delhi India
| | - Achal K. Srivastava
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | - Kishore K. Deepak
- Department of Physiology All India Institute of Medical Sciences New Delhi India
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9
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Li K, Rüdiger H, Ziemssen T. Spectral Analysis of Heart Rate Variability: Time Window Matters. Front Neurol 2019; 10:545. [PMID: 31191437 PMCID: PMC6548839 DOI: 10.3389/fneur.2019.00545] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 05/07/2019] [Indexed: 12/22/2022] Open
Abstract
Spectral analysis of heart rate variability (HRV) is a valuable tool for the assessment of cardiovascular autonomic function. Fast Fourier transform and autoregressive based spectral analysis are two most commonly used approaches for HRV analysis, while new techniques such as trigonometric regressive spectral (TRS) and wavelet transform have been developed. Short-term (on ECG of several minutes) and long-term (typically on ECG of 1–24 h) HRV analyses have different advantages and disadvantages. This article reviews the characteristics of spectral HRV studies using different lengths of time windows. Short-term HRV analysis is a convenient method for the estimation of autonomic status, and can track dynamic changes of cardiac autonomic function within minutes. Long-term HRV analysis is a stable tool for assessing autonomic function, describe the autonomic function change over hours or even longer time spans, and can reliably predict prognosis. The choice of appropriate time window is essential for research of autonomic function using spectral HRV analysis.
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Affiliation(s)
- Kai Li
- Autonomic and Neuroendocrinological Lab, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany.,Department of Neurology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Heinz Rüdiger
- Autonomic and Neuroendocrinological Lab, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Tjalf Ziemssen
- Autonomic and Neuroendocrinological Lab, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany.,Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
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10
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Chadda KR, Ajijola OA, Vaseghi M, Shivkumar K, Huang CLH, Jeevaratnam K. Ageing, the autonomic nervous system and arrhythmia: From brain to heart. Ageing Res Rev 2018; 48:40-50. [PMID: 30300712 DOI: 10.1016/j.arr.2018.09.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 08/21/2018] [Accepted: 09/30/2018] [Indexed: 02/08/2023]
Abstract
An ageing myocardium possesses significant electrophysiological alterations that predisposes the elderly patient to arrhythmic risk. Whilst these alterations are intrinsic to the cardiac myocytes, they are modulated by the cardiac autonomic nervous system (ANS) and consequently, ageing of the cardiac ANS is fundamental to the development of arrhythmias. A systems-based approach that incorporates the influence of the cardiac ANS could lead to better mechanistic understanding of how arrhythmogenic triggers and substrates interact spatially and temporally to produce sustained arrhythmia and why its incidence increases with age. Despite the existence of physiological oscillations of ANS activity on the heart, pathological oscillations can lead to defective activation and recovery properties of the myocardium. Such changes can be attributable to the decrease in functionality and structural alterations to ANS specific receptors in the myocardium with age. These altered ANS adaptive responses can occur either as a normal ageing process or accelerated in the presence of specific cardiac pathologies, such as genetic mutations or neurodegenerative conditions. Targeted intervention that seek to manipulate the ageing ANS influence on the myocardium may prove to be an efficacious approach for the management of arrhythmia in the ageing population.
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Affiliation(s)
- Karan R Chadda
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7AL, United Kingdom; Physiological Laboratory, University of Cambridge, Downing Street, Cambridge, CB2 3EG, United Kingdom
| | - Olujimi A Ajijola
- UCLA Cardiac Arrhythmia Center, UCLA Health System/David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center, UCLA Health System/David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System/David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Christopher L-H Huang
- Physiological Laboratory, University of Cambridge, Downing Street, Cambridge, CB2 3EG, United Kingdom; Department of Biochemistry, Hopkins Building, University of Cambridge, Cambridge, CB2 1QW, United Kingdom
| | - Kamalan Jeevaratnam
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7AL, United Kingdom; Physiological Laboratory, University of Cambridge, Downing Street, Cambridge, CB2 3EG, United Kingdom.
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11
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Watano C, Shiota Y, Onoda K, Sheikh AM, Mishima S, Nitta E, Yano S, Yamaguchi S, Nagai A. Evaluation of autonomic functions of patients with multiple system atrophy and Parkinson's disease by head-up tilt test. J Neural Transm (Vienna) 2017; 125:153-162. [PMID: 29185078 DOI: 10.1007/s00702-017-1816-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 11/16/2017] [Indexed: 01/08/2023]
Abstract
The aim of this study was to evaluate the autonomic neural function in Parkinson's disease (PD) and multiple system atrophy (MSA) with head-up tilt test and spectral analysis of cardiovascular parameters. This study included 15 patients with MSA, 15 patients with PD, and 29 healthy control (HC) subjects. High frequency power of the RR interval (RR-HF), the ratio of low frequency power of RR interval to RR-HF (RR-LF/HF) and LF power of systolic BP were used to evaluate parasympathetic, cardiac sympathetic and vasomotor sympathetic functions, respectively. Both patients with PD and MSA showed orthostatic hypotension and lower parasympathetic function (RR-HF) at tilt position as compared to HC subjects. Cardiac sympathetic function (RR-LF/HF) was significantly high in patients with PD than MSA at supine position. RR-LF/HF tended to increase in MSA and HC, but decreased in PD by tilting. Consequently, the change of the ratio due to tilting (ΔRR-LF/HF) was significantly lower in patients with PD than in HC subjects. Further analysis showed that compared to mild stage of PD, RR-LF/HF at the supine position was significantly higher in advanced stage. By tilting, it was increased in mild stage and decreased in the advanced stage of PD, causing ΔRR-LF/HF to decrease significantly in the advanced stage. Thus, we demonstrated that spectral analysis of cardiovascular parameters is useful to identify sympathetic and parasympathetic disorders in MSA and PD. High cardiac sympathetic function at the supine position, and its reduction by tilting might be a characteristic feature of PD, especially in the advanced stage.
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Affiliation(s)
- Chikako Watano
- Clinical Laboratory Division, Shimane University Hospital, Izumo, Japan
| | - Yuri Shiota
- Clinical Laboratory Division, Shimane University Hospital, Izumo, Japan
| | - Keiichi Onoda
- Department of Internal Medicine III, Shimane University Faculty of Medicine, Izumo, Japan
| | - Abdullah Md Sheikh
- Department of Laboratory Medicine, Shimane University School of Medicine, 89-1 Enya Cho, Izumo, 693-8501, Japan
| | - Seiji Mishima
- Clinical Laboratory Division, Shimane University Hospital, Izumo, Japan
| | - Eri Nitta
- Clinical Laboratory Division, Shimane University Hospital, Izumo, Japan
| | - Shozo Yano
- Department of Laboratory Medicine, Shimane University School of Medicine, 89-1 Enya Cho, Izumo, 693-8501, Japan
| | - Shuhei Yamaguchi
- Department of Internal Medicine III, Shimane University Faculty of Medicine, Izumo, Japan
| | - Atsushi Nagai
- Clinical Laboratory Division, Shimane University Hospital, Izumo, Japan. .,Department of Laboratory Medicine, Shimane University School of Medicine, 89-1 Enya Cho, Izumo, 693-8501, Japan.
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Li K, Lindauer C, Haase R, Rüdiger H, Reichmann H, Reuner U, Ziemssen T. Autonomic Dysfunction in Wilson's Disease: A Comprehensive Evaluation during a 3-Year Follow Up. Front Physiol 2017; 8:778. [PMID: 29066979 PMCID: PMC5641386 DOI: 10.3389/fphys.2017.00778] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 09/22/2017] [Indexed: 01/28/2023] Open
Abstract
Objectives: Wilson's disease is reported to have autonomic dysfunction, but comprehensive evaluation of autonomic function is lacking. Additionally, little is known about the change of autonomic function of Wilson's disease during continuous therapy. We assumed that patients with Wilson's disease had both sympathetic and parasympathetic autonomic impairments, and the autonomic dysfunction might be stable across a 3-year follow-up after years of optimal treatment. Methods: Twenty-six patients with Wilson's disease and twenty-six healthy controls were recruited. Twenty patients in the Wilson's disease group were examined again after a 3-year follow-up. All the participants were evaluated by a questionnaire on dysautonomia symptoms, 24-h blood pressure and heart rate monitoring, and cardiovascular autonomic function examination in various conditions including at rest, deep breathing, Valsalva maneuver, isometric handgrip test and passive tilting. Baroreflex sensitivity and spectral analyses were performed via trigonometric regressive spectral analysis. Results: Patients with Wilson's disease showed autonomic dysfunction mainly in the following aspects: (1) the heart rate was higher than the controls. (2) Valsalva ratio was lower in patients with Wilson's disease compared with the controls. (3) Heart rate increase during isometric hand gripping was smaller in the Wilson's disease patients than the controls. (4) Baroreflex sensitivity was lower during nearly all the cardiovascular autonomic function examinations compared with healthy controls. When tested 3 years later, baroreflex sensitivity at rest decreased compared with baseline. (5) There were mild declines of resting DBP and low frequency component of heart rate variability during the follow-up examination compared with baseline. (6) Subgroup analysis showed that patients initially presenting with neurological symptoms had a higher night-time heart rate, lower expiration: inspiration RR interval ratio (E/I ratio), lower expiration: inspiration RR interval difference (E-I difference), less increase of heart rate and diastolic blood pressure during the handgrip test, and lower baroreflex sensitivity during deep breathing than the control group. (7) Correlation analysis showed that the severity of neurological symptoms was associated with E/I ratio, E-I difference, Valsalva ratio, heart rate change during the handgrip test, and baroreflex sensitivity during deep breathing. Conclusions: The present study reveals cardiovascular autonomic dysfunction involving both sympathetic and parasympathetic branches in Wilson's disease patients, which is especially significant in the patients with neurological onset. Autonomic function is generally stable undergoing optimal maintenance treatment in patients with Wilson's disease. Though there might be mild changes of specific parameters.
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Affiliation(s)
- Kai Li
- Department of Neurology, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany.,Department of Neurology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Charlotte Lindauer
- Department of Neurology, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Rocco Haase
- Department of Neurology, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Heinz Rüdiger
- Department of Neurology, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Heinz Reichmann
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Ulrike Reuner
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Tjalf Ziemssen
- Department of Neurology, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany.,Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
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13
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Li K, Haase R, Rüdiger H, Reimann M, Reichmann H, Wolz M, Ziemssen T. Subthalamic nucleus stimulation and levodopa modulate cardiovascular autonomic function in Parkinson's disease. Sci Rep 2017; 7:7012. [PMID: 28765629 PMCID: PMC5539113 DOI: 10.1038/s41598-017-07429-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/28/2017] [Indexed: 11/14/2022] Open
Abstract
We aimed to explore the effects of bilateral subthalamic nucleus stimulation and levodopa on cardiovascular autonomic function in Parkinson’s disease. Twenty-six Parkinson’s disease patients with bilateral subthalamic nucleus stimulation in a stable state were tested under stimulation off and dopaminergic medication off (OFF-OFF), stimulation on and dopaminergic medication off (ON-OFF), and stimulation on and medication (levodopa) on (ON-ON) conditions by recording continuously blood pressure, ECG, and respiration at rest, during metronomic deep breathing, and head-up tilt test. Thirteen patients were diagnosed as orthostatic hypotension by head-up tilt test. Baroreflex sensitivity and spectral analyses were performed by trigonometric regressive spectral analysis. Subthalamic nucleus stimulation and levodopa had multiple influences. (1) Systolic blood pressure during tilt-up was reduced by subthalamic nucleus stimulation, and then further by levodopa. (2) Subthalamic nucleus stimulation and levodopa had different effects on sympathetic and parasympathetic regulations in Parkinson’s disease. (3) Levodopa decreased baroreflex sensitivity and RR interval only in the orthostatic hypotension group, and had opposite effects on the non-orthostatic hypotension group. These findings indicate that subthalamic nucleus stimulation and levodopa have different effects on cardiovascular autonomic function in Parkinson’s disease, which are modulated by the presence of orthostatic hypotension as well.
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Affiliation(s)
- Kai Li
- Autonomic and neuroendocrinological lab, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden University of Technology, Fetscherstr. 74, 01307, Dresden, Germany.,Department of Neurology, Beijing Hospital, National Center of Gerontology, China. No. 1 DaHua Road, Dongdan, Beijing, 100730, China
| | - Rocco Haase
- Autonomic and neuroendocrinological lab, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden University of Technology, Fetscherstr. 74, 01307, Dresden, Germany
| | - Heinz Rüdiger
- Autonomic and neuroendocrinological lab, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden University of Technology, Fetscherstr. 74, 01307, Dresden, Germany
| | - Manja Reimann
- Autonomic and neuroendocrinological lab, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden University of Technology, Fetscherstr. 74, 01307, Dresden, Germany
| | - Heinz Reichmann
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Fetscherstr. 74, 01307, Dresden, Germany
| | - Martin Wolz
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Fetscherstr. 74, 01307, Dresden, Germany
| | - Tjalf Ziemssen
- Autonomic and neuroendocrinological lab, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden University of Technology, Fetscherstr. 74, 01307, Dresden, Germany. .,Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Fetscherstr. 74, 01307, Dresden, Germany.
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14
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Decreased baroreflex sensitivity in Parkinson's disease is associated with orthostatic hypotension. J Neurol Sci 2017; 377:207-211. [DOI: 10.1016/j.jns.2017.03.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 03/11/2017] [Accepted: 03/27/2017] [Indexed: 11/18/2022]
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15
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Scorza FA, Cavalheiro EA, Scorza CA, Ferraz HB. Sudden unexpected death in Parkinson's disease: Perspectives on what we have learned about sudden unexpected death in epilepsy (SUDEP). Epilepsy Behav 2016; 57:124-125. [PMID: 26949153 DOI: 10.1016/j.yebeh.2016.01.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 01/30/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Fulvio A Scorza
- Disciplina de Neurociência, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil.
| | - Esper A Cavalheiro
- Disciplina de Neurociência, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - Carla A Scorza
- Disciplina de Neurociência, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - Henrique B Ferraz
- Departamento de Neurologia, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
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16
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Roy S, Jaryal AK, Srivastava AK, Deepak KK. Cardiovagal Baroreflex Sensitivity in Parkinson's Disease and Multiple-System Atrophy. J Clin Neurol 2016; 12:218-23. [PMID: 26869371 PMCID: PMC4828569 DOI: 10.3988/jcn.2016.12.2.218] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 11/02/2015] [Accepted: 11/05/2015] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose Parkinson's disease (PD) and multiple-system atrophy of the parkinsonian type (MSA-P) are progressive neurodegenerative disorders that in addition to dysfunction of the motor system also present with features of dysautonomia, frequently manifesting as orthostatic hypotension (OH). The pathophysiology of OH has been proposed to differ between these two disorders. This study investigated the spontaneous and cardiovagal baroreflex sensitivity (BRS) in Parkinson's disease patients with orthostatic hypotension (PDOH) and multiple system atrophy of Parkinsonian type with orthostatic hypotension in an attempt to differentiate the two disorders. Methods Two methods were used for determining the BRS: a spontaneous method (spontaneous BRS) and the reflexive baroreflex gain (cardiovagal BRS) from phases II and IV of the Valsalva maneuver (VM) in PDOH and MSA-POH. Results The spontaneous BRS (5.04±0.66 ms/mm Hg vs. 4.78±0.64 ms/mm Hg, p=0.54) and the cardiovagal BRS from phase II of the VM (0.96±0.75 ms/mm Hg vs. 1.34±1.51 ms/mm Hg, p=0.76) did not differ between PDOH and MSA-POH, but the cardiovagal BRS from phase IV of the VM (0.03±0.07 ms/mm Hg vs. 2.86±2.39 ms/mm Hg, p=0.004) was significantly lower in PDOH. Conclusions The cardiovagal BRS from phase IV of the VM has potential for differentiating PDOH and MSA-POH, indicating a difference in the pathophysiological mechanisms underlying the autonomic dysfunction in the two disorders.
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17
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Scorza FA, Scorza CA, Ferraz HB. Domperidone, Parkinson disease and sudden cardiac death: Mice and men show the way. Clinics (Sao Paulo) 2016; 71:59-61. [PMID: 26934232 PMCID: PMC4760361 DOI: 10.6061/clinics/2016(02)01] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Fulvio A Scorza
- Universidade Federal de São Paulo (EPM/UNIFESP), Escola Paulista de Medicina, Disciplina de Neurociência, São Paulo/SP, Brazil
| | - Carla A Scorza
- Universidade Federal de São Paulo (EPM/UNIFESP), Escola Paulista de Medicina, Disciplina de Neurociência, São Paulo/SP, Brazil
| | - Henrique B Ferraz
- Universidade Federal de São Paulo (EPM/UNIFESP), Escola Paulista de Medicina, Disciplina de Neurologia, São Paulo/SP, Brazil
- E-mail:
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18
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Li K, Reichmann H, Ziemssen T. Recognition and treatment of autonomic disturbances in Parkinson’s disease. Expert Rev Neurother 2015; 15:1189-203. [DOI: 10.1586/14737175.2015.1095093] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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19
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Solla P, Cadeddu C, Cannas A, Deidda M, Mura N, Mercuro G, Marrosu F. Heart rate variability shows different cardiovascular modulation in Parkinson's disease patients with tremor dominant subtype compared to those with akinetic rigid dominant subtype. J Neural Transm (Vienna) 2015; 122:1441-6. [PMID: 25797035 DOI: 10.1007/s00702-015-1393-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 03/09/2015] [Indexed: 10/23/2022]
Abstract
Parkinson's disease (PD) can present with different motor subtypes depending on the predominant symptoms (tremor or rigidity/bradykinesia). Slower disease progression and less cognitive decline are observed in tremor-dominant patients compared to those with akinetic-rigid subtype. Autonomic cardiovascular disorders have been described in parkinsonian patients, although the definite correlations with different subtypes of PD are not clear. In this context, heart rate variability (HRV) analysis represents a non-invasive and established tool in assessing cardiovascular autonomic modulation. We investigate cardiovascular autonomic modulation in PD patients with tremor dominant subtype in comparison to akinetic rigid dominant subtype subjects using HRV analysis. Twenty-eight PD patients (17 with tremor dominant subtype and 11 with akinetic rigid dominant subtype) were enrolled and compared to 17 age and sex-matched healthy controls. HRV was analyzed in time- and frequency-domains. Low-frequency (LF) values were significantly lower in the akinetic rigid dominant subtype than in the tremor dominant group [LF 41.4 ± 13.6 vs 55.5 ± 11.6 (p < 0.007)] indicating that the disease led to a more evident impairment of the baroreflex modulation of the autonomic outflow mediated by both sympathetic and parasympathetic systems in the first class of patients. These findings support the biological relevance of clinical subtypes supporting the idea of a different pathophysiological process between these subtypes. These differences also suggest that different subtypes may also result in different responses to therapy or in the possible development of cardiovascular side effects of dopaminergic drugs in these different populations.
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Affiliation(s)
- Paolo Solla
- Department of Public Health, Clinical and Molecular Medicine, Movement Disorders Centre, University of Cagliari, Cagliari, Italy
| | - Christian Cadeddu
- Department of Medical Sciences "Mario Aresu", University Hospital of Cagliari, University of Cagliari, Strada Statale 554, Km 4.500, Monserrato, 09042, Cagliari, Italy.
| | - Antonino Cannas
- Department of Public Health, Clinical and Molecular Medicine, Movement Disorders Centre, University of Cagliari, Cagliari, Italy
| | - Martino Deidda
- Department of Medical Sciences "Mario Aresu", University Hospital of Cagliari, University of Cagliari, Strada Statale 554, Km 4.500, Monserrato, 09042, Cagliari, Italy
| | - Nicola Mura
- Department of Medical Sciences "Mario Aresu", University Hospital of Cagliari, University of Cagliari, Strada Statale 554, Km 4.500, Monserrato, 09042, Cagliari, Italy
| | - Giuseppe Mercuro
- Department of Medical Sciences "Mario Aresu", University Hospital of Cagliari, University of Cagliari, Strada Statale 554, Km 4.500, Monserrato, 09042, Cagliari, Italy
| | - Francesco Marrosu
- Department of Public Health, Clinical and Molecular Medicine, Movement Disorders Centre, University of Cagliari, Cagliari, Italy
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20
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Delgado G, Estañol B, Rodríguez-Violante M, Martínez-Memije R, Infante-Vázquez Ó, Bertado-Ramírez N. Cardiovascular variability in Mexican patients with Parkinson's disease. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:762-7. [DOI: 10.1590/0004-282x20140125] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 07/15/2014] [Indexed: 11/22/2022]
Abstract
Cardiovascular variability (CVV) has been evaluated in patients with Parkinson's disease (PD) in other countries and exhibit ethnic differences. Objective We investigated heart rate variability (HRV) and blood pressure variability (BPV) in Mexican patients with PD. Method We further compared HRV and BPV between this group and young healthy controls (YHC) in order to estimate, for the first time in our country, the magnitude of the difference. Twenty patients were examined. Time- and frequency-domain CVV parameters were studied during supine rest (SR), active standing (AS) and controlled breathing. These measurements were compared to those of 20 YHC. Results In the three conditions tested, our study showed a decrease in almost all HRV parameters in PD patients; on the contrary, decreased BPV parameters were found less frequently and only during SR and AS. Conclusion Our results indicate that HRV is impaired in PD. Some BPV parameters are also diminished.
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Affiliation(s)
- Guillermo Delgado
- National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico
| | - Bruno Estañol
- National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico
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21
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Time- and frequency-domain parameters of heart rate variability and sympathetic skin response in Parkinson's disease. J Neural Transm (Vienna) 2014; 122:419-25. [PMID: 25038873 DOI: 10.1007/s00702-014-1276-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 07/15/2014] [Indexed: 10/25/2022]
Abstract
The autonomic nervous system (ANS) is regularly affected in Parkinson's disease (PD). Information on autonomic dysfunction can be derived from e.g. altered heart rate variability (HRV) and sympathetic skin response (SSR). Such parameters can be quantified easily and measured repeatedly which might be helpful for evaluating disease progression and therapeutic outcome. In this 2-center study, HRV and SSR of 45 PD patients and 26 controls were recorded. HRV was measured during supine metronomic breathing and analyzed in time- and frequency-domains. SSR was evoked by repetitive auditory stimulation. Various ANS parameters were compared (1) between patients and healthy controls, (2) to clinical scales (Unified Parkinson's disease rating scale, Mini-Mental State Examination, Becks Depression Inventory), and (3) to disease duration. Root mean square of successive differences (RMSSD) and low frequency/high frequency (LF/HF) ratio differed significantly between PD and controls. Both, HRV and SSR parameters showed low or no association with clinical scores. Time-domain parameters tended to be affected already at early PD stages but did not consistently change with longer disease duration. In contrast, frequency-domain parameters were not altered in early PD phases but tended to be lower (LF, LF/HF ratio), respectively higher (HF) with increasing disease duration. This report confirms previous results of altered ANS parameters in PD. In addition, it suggests that (1) these ANS parameters are not relevantly associated with motor, behavioral, and cognitive changes in PD, (2) time-domain parameters are useful for the assessment of early PD, and (3) frequency-domain parameters are more closely associated with disease duration.
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Finsterer J, Wahbi K. CNS-disease affecting the heart: brain-heart disorders. J Neurol Sci 2014; 345:8-14. [PMID: 25034054 DOI: 10.1016/j.jns.2014.07.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 05/27/2014] [Accepted: 07/01/2014] [Indexed: 01/09/2023]
Abstract
There are a number of hereditary and non-hereditary central nervous system (CNS) disorders, which directly or indirectly affect the heart (brain-heart disorders). The most well-known of these CNS-disorders are epilepsy, stroke, subarachanoid bleeding, bacterial meningitis, and head injury. In addition, a number of hereditary and non-hereditary neurodegenerative disorders may impair cardiac functions. Affection of the heart may manifest as arrhythmias, cardiomyopathy, or autonomic dysfunction. Rarer cardiac complications of CNS disorders include heart failure, systolic or diastolic dysfunction, myocardial infarction, arterial hypertension, or pulmonary hypertension. Cardiomyopathy induced by hereditary CNS disease mainly include stress-induced myocardial dysfunction, known as Takotsubo syndrome (TTS). CNS disease triggering TTS includes epilepsy, ischemic stroke, subarachnoid bleeding, or PRES syndrome. Arrhythmias induced by hereditary CNS disease include supraventricular or ventricular arrhythmias leading to palpitations, dizziness, vertigo, fainting, syncope, (near) sudden cardiac death, or sudden unexplained death in epilepsy (SUDEP). Appropriate management of cardiac involvement in CNS-disorders is essential to improve outcome of affected patients.
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Affiliation(s)
| | - Karim Wahbi
- Paris-Descartes, Sorbonne Paris Cite University, 75006 Paris, France; AP-HP, Cardiology Department, Cochin Hospital, Paris, France; AP-HP, Pitié-Salpêtrière Hospital, Neurology Department, Paris, France
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23
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Trigonometric regressive spectral analysis: an innovative tool for evaluating the autonomic nervous system. J Neural Transm (Vienna) 2013; 120 Suppl 1:S27-33. [PMID: 23812502 DOI: 10.1007/s00702-013-1054-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 06/11/2013] [Indexed: 01/01/2023]
Abstract
Biological rhythms, describing the temporal variation of biological processes, are a characteristic feature of complex systems. The analysis of biological rhythms can provide important insights into the pathophysiology of different diseases, especially, in cardiovascular medicine. In the field of the autonomic nervous system, heart rate variability (HRV) and baroreflex sensitivity (BRS) describe important fluctuations of blood pressure and heart rate which are often analyzed by Fourier transformation. However, these parameters are stochastic with overlaying rhythmical structures. R-R intervals as independent variables of time are not equidistant. That is why the trigonometric regressive spectral (TRS) analysis--reviewed in this paper--was introduced, considering both the statistical and rhythmical features of such time series. The data segments required for TRS analysis can be as short as 20 s allowing for dynamic evaluation of heart rate and blood pressure interaction over longer periods. Beyond HRV, TRS also estimates BRS based on linear regression analyses of coherent heart rate and blood pressure oscillations. An additional advantage is that all oscillations are analyzed by the same (maximal) number of R-R intervals thereby providing a high number of individual BRS values. This ensures a high confidence level of BRS determination which, along with short recording periods, may be of profound clinical relevance. The dynamic assessment of heart rate and blood pressure spectra by TRS allows a more precise evaluation of cardiovascular modulation under different settings as has already been demonstrated in different clinical studies.
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Postuma RB, Aarsland D, Barone P, Burn DJ, Hawkes CH, Oertel W, Ziemssen T. Identifying prodromal Parkinson's disease: pre-motor disorders in Parkinson's disease. Mov Disord 2012; 27:617-26. [PMID: 22508280 DOI: 10.1002/mds.24996] [Citation(s) in RCA: 390] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Increasing recognition that Parkinson's disease (PD) may start outside of the substantia nigra has led to a rapidly expanding effort to define prodromal stages of PD, before motor signs permit classical diagnosis. Many of these efforts center around the identification of clinical non-motor symptoms and signs of disease. There is now direct evidence that olfaction, rapid eye movement (REM) sleep behavior disorder (RBD), constipation, and depression can be present in prodromal PD. In addition, there is suggestive evidence that visual changes, other autonomic symptoms, and subtle cognitive changes may also be present at prodromal stages. A critical issue in utility of these prodromal markers will be assessment of sensitivity, specificity, and positive and negative predictive values. Although these have yet to be fully defined, olfactory deficits, some visual changes, and autonomic symptoms occur in the majority of PD patients at diagnosis, suggesting good potential sensitivity. However, with the exception of RBD and perhaps some specific autonomic measures, specificity, and positive predictive value of these markers may be insufficient to be used alone as identifiers of prodromal disease. The evidence for the utility of olfaction, RBD, autonomic markers, visual changes, mood disorders, and cognitive loss as markers of prodromal PD and the potential sensitivity and specificity of these markers are summarized.
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Affiliation(s)
- Ronald B Postuma
- Department of Neurology, McGill University, Montreal General Hospital, Montreal, Quebec, Canada.
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25
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Chang KV, Chen WS, Wu RM, Chen SY, Shen HY, Lan C, Wang YH. Pulsed wave Doppler ultrasound is useful to assess vasomotor response in patients with multiple system atrophy and well correlated with tilt table study. ScientificWorldJournal 2012; 2012:548529. [PMID: 22262954 PMCID: PMC3259486 DOI: 10.1100/2012/548529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 10/31/2011] [Indexed: 01/22/2023] Open
Abstract
The study aim was to assess sympathetic vasomotor response (SVR) by using pulsed wave Doppler (PWD) ultrasound in patients with multiple system atrophy (MSA) and correlate with the tilt table study. We recruited 18 male patients and 10 healthy men as controls. The SVR of the radial artery was evaluated by PWD, using inspiratory cough as a provocative maneuver. The response to head-up tilt was studied by a tilt table with simultaneous heart rate and blood pressure recording. The hemodynamic variables were compared between groups, and were examined by correlation analysis. Regarding SVR, MSA patients exhibited a prolonged latency and less heart rate acceleration following inspiratory cough. Compared with the tilt table test, the elevation of heart rate upon SVR was positively correlated to the increase of heart rate after head-up tilt. The correlation analysis indicated that the magnitude of blood pressure drop from supine to upright was positively associated with the SVR latency but negatively correlated with the heart rate changes upon SVR. The present study demonstrated that blunted heart rate response might explain MSA's vulnerability to postural challenge. PWD may be used to predict cardiovascular response to orthostatic stress upon head-up tilt in MSA patients.
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Affiliation(s)
- Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei 10002, Taiwan
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Iodice V, Low DA, Vichayanrat E, Mathias CJ. Cardiovascular autonomic dysfunction in MSA and Parkinson's disease: Similarities and differences. J Neurol Sci 2011; 310:133-8. [DOI: 10.1016/j.jns.2011.07.014] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 06/27/2011] [Accepted: 07/11/2011] [Indexed: 02/02/2023]
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Sommer S, Aral-Becher B, Jost W. Nondipping in Parkinson's disease. PARKINSONS DISEASE 2011; 2011:897586. [PMID: 21941684 PMCID: PMC3175384 DOI: 10.4061/2011/897586] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 07/10/2011] [Accepted: 07/19/2011] [Indexed: 11/21/2022]
Abstract
Objective. The aim of this study was to identify patients with Parkinson's disease who showed loss or decrease of nocturnal blood pressure fall (nondipper patients) as a marker of autonomic dysfunction. Presence or absence of orthostatic hypotension was considered to investigate whether alterations in circadian blood pressure pattern are associated with posture-related dysregulation of blood pressure. Methods. 40 patients with Parkinson's disease underwent 24-hour blood pressure monitoring. 21 patients were diagnosed with arterial hypertension and received anti-hypertensive drugs. Nondipper patients were defined as having nocturnal decrease of mean systolic and diastolic blood pressure less than 10%. Presence or absence of orthostatic hypotension was determined by Schellong's test. Results. We identified 35 nondipper patients (88%). Nondipping was detected in 20 patients with orthostatic hypotension (95%) and in 15 patients without orthostatic hypotension (79%). 18 patients with hypertensive and 22 patients with normal blood pressure values were detected. Conclusions. In conclusion 24-hour blood pressure monitoring showed a high prevalence of nondipping in 40 patients with Parkinson's disease with and without orthostatic hypotension independent of coexisting arterial hypertension and antihypertensive treatment. 24-hour blood pressure monitoring may be useful to identify non-dipping as a marker of autonomic dysfunction in patients with Parkinson's disease.
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Affiliation(s)
- Sita Sommer
- Department of Neurology, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
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Ziemssen T, Reichmann H. Cardiovascular autonomic testing in extrapyramidal disorders. J Neurol Sci 2011; 310:129-32. [PMID: 21839477 DOI: 10.1016/j.jns.2011.07.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 06/28/2011] [Accepted: 07/19/2011] [Indexed: 10/17/2022]
Abstract
Various diagnostic tests are available to demonstrate autonomic failure in extrapyramidal disease. Autonomic function tests can identify parasympathetic and sympathetic dysfunction. While specialized tests are only available in autonomic labs, routine tests such as 24h ambulatory blood pressure measurements can be broadly used in clinical practice eg. as screening tests. In this review, we briefly introduce functional cardiovascular autonomic testing and propose a workup plan for patients with extrapyramidal disease. In all patients with extrapyramidal disease, screening for autonomic dysfunction should be performed. In the case of pathological findings, detailed autonomic testing should be considered with repeated measurements at follow up visits.
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Affiliation(s)
- Tjalf Ziemssen
- ANF-lab, Neurological University Clinic, Dresden, Germany.
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Ziemssen T, Fuchs G, Greulich W, Reichmann H, Schwarz M, Herting B. Treatment of dysautonomia in extrapyramidal disorders. J Neurol 2011; 258:S339-45. [DOI: 10.1007/s00415-011-5946-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Gasch J, Reimann M, Reichmann H, Rüdiger H, Ziemssen T. Determination of baroreflex sensitivity during the modified Oxford maneuver by trigonometric regressive spectral analysis. PLoS One 2011; 6:e18061. [PMID: 21437258 PMCID: PMC3060917 DOI: 10.1371/journal.pone.0018061] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 02/22/2011] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Differences in spontaneous and drug-induced baroreflex sensitivity (BRS) have been attributed to its different operating ranges. The current study attempted to compare BRS estimates during cardiovascular steady-state and pharmacologically stimulation using an innovative algorithm for dynamic determination of baroreflex gain. METHODOLOGY/PRINCIPAL FINDINGS Forty-five volunteers underwent the modified Oxford maneuver in supine and 60° tilted position with blood pressure and heart rate being continuously recorded. Drug-induced BRS-estimates were calculated from data obtained by bolus injections of nitroprusside and phenylephrine. Spontaneous indices were derived from data obtained during rest (stationary) and under pharmacological stimulation (non-stationary) using the algorithm of trigonometric regressive spectral analysis (TRS). Spontaneous and drug-induced BRS values were significantly correlated and display directionally similar changes under different situations. Using the Bland-Altman method, systematic differences between spontaneous and drug-induced estimates were found and revealed that the discrepancy can be as large as the gain itself. Fixed bias was not evident with ordinary least products regression. The correlation and agreement between the estimates increased significantly when BRS was calculated by TRS in non-stationary mode during the drug injection period. TRS-BRS significantly increased during phenylephrine and decreased under nitroprusside. CONCLUSIONS/SIGNIFICANCE The TRS analysis provides a reliable, non-invasive assessment of human BRS not only under static steady state conditions, but also during pharmacological perturbation of the cardiovascular system.
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Affiliation(s)
- Julia Gasch
- Autonomic and Neuroendocrinological Laboratory, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Manja Reimann
- Autonomic and Neuroendocrinological Laboratory, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
- Research Group Neuro-Metabolism, Department of Neurology and Internal Medicine III, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
- * E-mail:
| | - Heinz Reichmann
- Autonomic and Neuroendocrinological Laboratory, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Heinz Rüdiger
- Autonomic and Neuroendocrinological Laboratory, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
- Research Group Neuro-Metabolism, Department of Neurology and Internal Medicine III, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Tjalf Ziemssen
- Autonomic and Neuroendocrinological Laboratory, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
- Research Group Neuro-Metabolism, Department of Neurology and Internal Medicine III, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
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Trigonometric regressive spectral analysis reliably maps dynamic changes in baroreflex sensitivity and autonomic tone: the effect of gender and age. PLoS One 2010; 5:e12187. [PMID: 20808439 PMCID: PMC2922332 DOI: 10.1371/journal.pone.0012187] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 07/22/2010] [Indexed: 11/19/2022] Open
Abstract
Background The assessment of baroreflex sensitivity (BRS) has emerged as prognostic tool in cardiology. Although available computer-assisted methods, measuring spontaneous fluctuations of heart rate and blood pressure in the time and frequency domain are easily applicable, they do not allow for quantification of BRS during cardiovascular adaption processes. This, however, seems an essential criterion for clinical application. We evaluated a novel algorithm based on trigonometric regression regarding its ability to map dynamic changes in BRS and autonomic tone during cardiovascular provocation in relation to gender and age. Methodology/Principal Findings We continuously recorded systemic arterial pressure, electrocardiogram and respiration in 23 young subjects (25±2 years) and 22 middle-aged subjects (56±4 years) during cardiovascular autonomic testing (metronomic breathing, Valsalva manoeuvre, head-up tilt). Baroreflex- and spectral analysis was performed using the algorithm of trigonometric regressive spectral analysis. There was an age-related decline in spontaneous BRS and high frequency oscillations of RR intervals. Changes in autonomic tone evoked by cardiovascular provocation were observed as shifts in the ratio of low to high frequency oscillations of RR intervals and blood pressure. Respiration at 0.1 Hz elicited an increase in BRS while head-up tilt and Valsalva manoeuvre resulted in a downregulation of BRS. The extent of autonomic adaption was in general more pronounced in young individuals and declined stronger with age in women than in men. Conclusions/Significance The trigonometric regressive spectral analysis reliably maps age- and gender-related differences in baroreflex- and autonomic function and is able to describe adaption processes of baroreceptor circuit during cardiovascular stimulation. Hence, this novel algorithm may be a useful screening tool to detect abnormalities in cardiovascular adaption processes even when resting values appear to be normal.
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Mense L, Reimann M, Rüdiger H, Gahn G, Reichmann H, Hentschel H, Ziemssen T. Autonomic function and cerebral autoregulation in patients undergoing carotid endarterectomy. Circ J 2010; 74:2139-45. [PMID: 20689219 DOI: 10.1253/circj.cj-10-0365] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Carotid endarterectomy (CEA) is the first-line treatment in severe carotid stenosis to prevent stroke. Because of methodological limitations, the acute impact of CEA on baroreflex function and cerebral autoregulation is not well defined and was therefore investigated by applying a novel algorithm. METHODS AND RESULTS Systemic arterial blood pressure, ECG and respiration during metronomic breathing and Valsalva maneuver were continuously recorded in 18 patients with carotid stenosis before and after CEA, and in 10 healthy controls. Baroreflex sensitivity, frequency spectra of RR intervals and indices for cerebral autoregulation were evaluated by trigonometric regressive spectral analysis. Compared with the controls, patients had impaired baroreflex sensitivity. Baroreflex sensitivity and frequency spectra were not changed by CEA. Cerebral autoregulation of patients with carotid stenosis as calculated by phase shift was reduced compared with controls but it improved significantly after CEA. Improvement of cerebral autoregulation was independent of changes in cerebral blood flow velocity. CONCLUSIONS Baroreflex sensitivity and cerebral autoregulation are impaired in patients with carotid stenosis, conferring a high stroke risk. CEA improves cerebral autoregulation, but does not affect baroreflex sensitivity. For further risk reduction, interventional approaches targeting baroreflex function need to be considered.
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Affiliation(s)
- Lars Mense
- Autonomic and Neuroendocrinological Laboratory, Department of Neurology, Dresden University of Technology, School of Medicine Carl Gustav Carus, Dresden, Germany
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Friedrich C, Rüdiger H, Schmidt C, Herting B, Prieur S, Junghanns S, Schweitzer K, Globas C, Schöls L, Berg D, Reichmann H, Ziemssen T. Baroreflex sensitivity and power spectral analysis during autonomic testing in different extrapyramidal syndromes. Mov Disord 2010; 25:315-24. [PMID: 20014116 DOI: 10.1002/mds.22844] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Autonomic dysfunction has been frequently demonstrated in patients with extrapyramidal diseases by cardiovascular autonomic testing. In addition to classical testing, we applied the more detailed baroreflex and spectral analysis on three traditional cardiovascular tests in this study to get additional information on autonomic outflow. We recorded continuously blood pressure, electrocardiogram, and respiration in 35 patients with multiple system atrophy, 32 patients with progressive supranuclear palsy, 46 patients with idiopathic Parkinson's disease and in 27 corresponding healthy subjects during cardiovascular autonomic testing (metronomic breathing, Valsalva manoeuvre, head-up tilt). Baroreflex and spectral analyses were performed by using trigonometric regressive spectral analysis between and during the manoeuvres. Consistent with previous interpretations, our data showed an increase of sympathetic activity in head-up tilt and Valsalva test in healthy controls. This sympathetic activity was significantly decreased in patients with typical and atypical Parkinson syndromes. Significant modulation of baroreflex activity could be observed especially during metronomic breathing; again it was significantly lower in all patient groups. Baroreflex and spectral parameters could not only differentiate between patients and healthy controls, but also differentiate between clinically symptomatic (with autonomic dysfunction as eg. orthostatic hypotension) and asymptomatic patients. In conclusion, our approach allows the evaluation of autonomic variability during short and nonstationary periods of time and may constitute a useful advance in the assessment of autonomic function in both physiological and pathological conditions.
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Affiliation(s)
- Constanze Friedrich
- Autonomic and Neuroendocrinological Laboratory, University Clinic Carl Gustav Carus, Dresden University of Technology, Germany
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Pietzarka K, Reimann M, Schmidt C, Herting B, Schöls L, Reichmann H, Berg D, Schrader C, Ziemssen T. The cold hand sign in multiple system atrophy: skin perfusion revisited. J Neural Transm (Vienna) 2010; 117:475-9. [DOI: 10.1007/s00702-010-0375-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2009] [Accepted: 01/27/2010] [Indexed: 10/19/2022]
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Abstract
Although extrapyramidal diseases are commonly thought to solely affect the extrapyramidal motor system, nonmotor symptoms such as behavioural abnormalities, dysautonomia, sleep disturbances and sensory dysfunctions are also frequently observed. Autonomic dysfunction as an important clinical component of extrapyramidal disease (idiopathic Parkinson's disease, multiple system atrophy, progressive supranuclear palsy, dementia with Lewy bodies) is often not formally assessed and thus frequently misdiagnosed. Symptoms of autonomic dysfunction in general impact more on quality of life than motor symptoms. Appropriate symptom-oriented diagnosis and symptomatic treatment as part of an interdisciplinary approach can greatly benefit the patient. Unfortunately, double-blind, randomized, controlled studies are scarce with the consequence that most recommendations are not based on the highest level of evidence. This review elaborates a limited overview on the treatment of cardiovascular, gastrointestinal, urogenital and sudomotor autonomic dysfunction in various extrapyramidal syndromes.
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Affiliation(s)
- Tjalf Ziemssen
- ANF Laboratory, Department of Neurology, University Clinic Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
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Schmidt C, Berg D, Herting, Prieur S, Junghanns S, Schweitzer K, Globas C, Schöls L, Reichmann H, Ziemssen T. Loss of nocturnal blood pressure fall in various extrapyramidal syndromes. Mov Disord 2009; 24:2136-42. [DOI: 10.1002/mds.22767] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Reimann M, Schmidt C, Herting B, Prieur S, Junghanns S, Schweitzer K, Globas C, Schoels L, Reichmann H, Berg D, Ziemssen T. Comprehensive autonomic assessment does not differentiate between Parkinson’s disease, multiple system atrophy and progressive supranuclear palsy. J Neural Transm (Vienna) 2009; 117:69-76. [DOI: 10.1007/s00702-009-0313-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 09/04/2009] [Indexed: 10/20/2022]
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Abstract
Symptoms of cardiovascular dysautonomia are a common occurrence in Parkinson's disease (PD). In addition to this dysautonomia as part of PD itself, dysfunction of the autonomic nervous system (ANS) can be triggered as a side-effect of drug treatment interacting with the ANS or - if prominent and early - an indication of a different disease such as multiple system atrophy (MSA). Various diagnostic tests are available to demonstrate autonomic failure. While autonomic function tests can differentiate parasympathetic from sympathetic dysfunction, cardiac imaging can define the pathophysiologically involved site of a lesion. Standard tests such as 24-h ambulatory blood pressure measurements can identify significant autonomic failure which needs treatment. The most frequent and disturbing symptom of cardiovascular autonomic dysfunction is orthostatic hypotension. Symptoms include generalized weakness, light-headiness, mental "clouding" up to syncope. Factors like heat, food, alcohol, exercise, activities which increase intrathoraric pressure (e.g. defecation, coughing) and certain drugs (e.g. vasodilators) can worsen a probably asymptomatic orthostatic hypotension. Non-medical and medical therapies can help the patient to cope with a disabling symptomatic orthostatic hypotension. Supine hypertension is often associated with orthostatic hypotension. The prognostic role of cardiovagal and baroreflex dysfunction is still not yet known.
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Valsalva manoeuvre in patients with different Parkinsonian disorders. J Neural Transm (Vienna) 2009; 116:875-80. [DOI: 10.1007/s00702-009-0239-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 05/01/2009] [Indexed: 10/20/2022]
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